Provider Demographics
NPI:1932517273
Name:LUNA, ENRIQUE (ATC, LAT, LMT)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:ATC, LAT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 HIGHLAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7732
Mailing Address - Country:US
Mailing Address - Phone:321-953-5803
Mailing Address - Fax:
Practice Address - Street 1:2351 MALABAR RD NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7203
Practice Address - Country:US
Practice Address - Phone:321-722-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 10732255A2300X
FLMA 46769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist